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Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers: A Systematic Review and Meta-analysis.
JAMA Dermatol. 2018 11 01; 154(11):1304-1311.JD

Abstract

Importance

Exercise is recommended as an adjuvant treatment for venous leg ulceration (VLU) to improve calf muscle pump function. However, the association of exercise with VLU healing has not been properly aggregated, and the effectiveness of different exercise interventions has not been characterized.

Objective

To summarize the association of different exercise interventions with VLU healing when used as an adjuvant to any form of compression.

Data Sources

The Cochrane Controlled Trials Register, MEDLINE, Embase, CINAHL, PsycInfo, and SCOPUS databases were searched through October 9, 2017.

Study Selection

Randomized clinical trials (RCTs) of any exercise compared with no exercise in participants with VLU were included, where compression was used as standard therapy and a healing outcome was reported. Independent title screening and full text review by 2 authors (A.J., J.S.) with appeal to a third author (J.P.) if disagreement was unresolved. Of the 519 articles screened, a total of 6 (1.2%) studies met the inclusion criteria for systematic review, including 5 for meta-analysis.

Data Extraction and Synthesis

Independent quality assessment for Cochrane risk of bias and data extraction by 2 authors with appeal to third author if disagreement unresolved (PRISMA). Data pooled using fixed effects model.

Main Outcomes and Measures

The a priori primary outcome was any healing outcome (proportion healed, time to healing, or change in ulcer area). Secondary outcomes (adverse events, costs, and health-related quality of life) were only collected if a primary outcome was reported.

Results

Six RCTs were identified and 5 (190 participants) met inclusion criteria for meta-analysis. The exercise interventions were progressive resistance exercise alone (2 RCTs, 53 participants) or combined with prescribed physical activity (2 RCTs, 102 participants), walking only (1 RCT, 35 participants), or ankle exercises (1 RCT, 40 participants). Overall, exercise was associated with increased VLU healing at 12 weeks although the effect was imprecise (additional 14 cases healed per 100 patients; 95% CI, 1-27 cases per 100; P = .04). The combination of progressive resistance exercise plus prescribed physical activity appeared to be most effective, again with imprecision (additional 27 cases healed per 100 patients; 95% CI, 9-45 cases per 100; P = .004).

Conclusions and Relevance

The evidence base may now be sufficiently suggestive for clinicians to consider recommending simple progressive resistance and aerobic activity to suitable patients with VLU while further research is produced.

Authors+Show Affiliations

School of Nursing, University of Auckland, New Zealand. National Institute for Health Innovation, University of Auckland, New Zealand.School of Nursing, University of Auckland, New Zealand.School of Nursing, University of Auckland, New Zealand.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

30285080

Citation

Jull, Andrew, et al. "Prescribed Exercise With Compression Vs Compression Alone in Treating Patients With Venous Leg Ulcers: a Systematic Review and Meta-analysis." JAMA Dermatology, vol. 154, no. 11, 2018, pp. 1304-1311.
Jull A, Slark J, Parsons J. Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers: A Systematic Review and Meta-analysis. JAMA Dermatol. 2018;154(11):1304-1311.
Jull, A., Slark, J., & Parsons, J. (2018). Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers: A Systematic Review and Meta-analysis. JAMA Dermatology, 154(11), 1304-1311. https://doi.org/10.1001/jamadermatol.2018.3281
Jull A, Slark J, Parsons J. Prescribed Exercise With Compression Vs Compression Alone in Treating Patients With Venous Leg Ulcers: a Systematic Review and Meta-analysis. JAMA Dermatol. 2018 11 1;154(11):1304-1311. PubMed PMID: 30285080.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers: A Systematic Review and Meta-analysis. AU - Jull,Andrew, AU - Slark,Julia, AU - Parsons,John, PY - 2018/10/5/pubmed PY - 2019/9/26/medline PY - 2018/10/5/entrez SP - 1304 EP - 1311 JF - JAMA dermatology JO - JAMA Dermatol VL - 154 IS - 11 N2 - Importance: Exercise is recommended as an adjuvant treatment for venous leg ulceration (VLU) to improve calf muscle pump function. However, the association of exercise with VLU healing has not been properly aggregated, and the effectiveness of different exercise interventions has not been characterized. Objective: To summarize the association of different exercise interventions with VLU healing when used as an adjuvant to any form of compression. Data Sources: The Cochrane Controlled Trials Register, MEDLINE, Embase, CINAHL, PsycInfo, and SCOPUS databases were searched through October 9, 2017. Study Selection: Randomized clinical trials (RCTs) of any exercise compared with no exercise in participants with VLU were included, where compression was used as standard therapy and a healing outcome was reported. Independent title screening and full text review by 2 authors (A.J., J.S.) with appeal to a third author (J.P.) if disagreement was unresolved. Of the 519 articles screened, a total of 6 (1.2%) studies met the inclusion criteria for systematic review, including 5 for meta-analysis. Data Extraction and Synthesis: Independent quality assessment for Cochrane risk of bias and data extraction by 2 authors with appeal to third author if disagreement unresolved (PRISMA). Data pooled using fixed effects model. Main Outcomes and Measures: The a priori primary outcome was any healing outcome (proportion healed, time to healing, or change in ulcer area). Secondary outcomes (adverse events, costs, and health-related quality of life) were only collected if a primary outcome was reported. Results: Six RCTs were identified and 5 (190 participants) met inclusion criteria for meta-analysis. The exercise interventions were progressive resistance exercise alone (2 RCTs, 53 participants) or combined with prescribed physical activity (2 RCTs, 102 participants), walking only (1 RCT, 35 participants), or ankle exercises (1 RCT, 40 participants). Overall, exercise was associated with increased VLU healing at 12 weeks although the effect was imprecise (additional 14 cases healed per 100 patients; 95% CI, 1-27 cases per 100; P = .04). The combination of progressive resistance exercise plus prescribed physical activity appeared to be most effective, again with imprecision (additional 27 cases healed per 100 patients; 95% CI, 9-45 cases per 100; P = .004). Conclusions and Relevance: The evidence base may now be sufficiently suggestive for clinicians to consider recommending simple progressive resistance and aerobic activity to suitable patients with VLU while further research is produced. SN - 2168-6084 UR - https://www.unboundmedicine.com/medline/citation/30285080/full_citation L2 - https://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2018.3281 DB - PRIME DP - Unbound Medicine ER -